“He was awesome,” Alexis Pleus, executive director of Truth Pharm, a small harm reduction organization based in Binghamton, New York, said of her son. “Really outgoing. Loved sports.” As a high school junior, Jeff injured his knee and doctors quickly prescribed opioids. She recalled reminding him to take his pills. “I had no idea what this meant.”
The large majority of people who are prescribed opioids don’t develop opioid use disorder (OUD)—an important reality, amid an ongoing crackdown on pain patients. But her son did. For seven years, he successfully hid it, finding good work and showing no signs of trouble. Until one day, he was caught burglarizing houses.
“I was blown away. It made no sense, I couldn’t believe it. And that’s how I found out,” Pleus told Filter. He’d land in jail twice. He managed to stay in recovery for 20 months. “And then I lost him.” Jeff was 28.
Her middle son also struggled with opioid use. And she hates the advice she was given in standard recovery programs: to administer “tough love,” or to wait for her son to “hit rock bottom.”
“How do you wait for a child to hit rock bottom?” Pleus asked. With the help of Suboxone, and support not predicated on “tough love,” her other son is now thriving.
Much of the money, she said, is going to entities including large hospitals. “That one really gets my ass!”
Like many parents who have lost children to overdose, Pleus became active in harm reduction advocacy, founding Truth Pharm in 2015. The group does community outreach, and gives presentations in schools, to medical professionals and local business leaders. They aim to lift stigma and promote harm reduction interventions like naloxone, syringe access and medications for OUD. They also run a syringe service program and see up to 60 people a day in their offices, providing them with personal care items “to survive,” and links to medical services.
But like so many grassroots groups, their work is hampered by a lack of funding. That’s where money from New York State’s Opioid Settlement Fund (OSF) could come in. After lawsuits targeting pharmaceutical companies, the fund reached $3 billion. That money has been administered over the course of three years. It’s meant to go to programs that help reduce overdose deaths. But Pleus said small organizations like hers, despite being deeply rooted in their communities, are being sidelined.
Much of the money, she said, is going to entities including large hospitals. “That one really gets my ass! Hospital CEO salaries are more than what they get [from OSF funding], and they don’t do anything about treating addiction.”
A new report by the Drug Policy Alliance audited the first three years of New York’s OSF spending. It found that in Financial Year 23-24, more than 80 percent went to large organizations that pursue statewide initiatives and/or are affiliated with major institutions. Only 19 percent has gone to small local groups, which most often serve a single community with a budget below $5 million.
“It is critical that opioid settlement funds are protected from filling budget gaps … and used effectively as supplemental resources to address the overdose crisis.”
Though overdose deaths are decreasing overall, vulnerable populations remain at great risk: Between 2019 and 2023 Black and Native New Yorkers had the highest rates of overdose fatalities, with deaths increasing substantially, even as they remained stable for other demographics.
As the Trump administration plans to slash Medicaid and other programs—and favors old-fashioned, ineffective models of treatment—funding for small harm reduction community groups is dire.
“In the face of these challenges, it is critical that opioid settlement funds are protected from filling budget gaps created by federal funding cuts and used effectively as supplemental resources to address the overdose crisis,” the report states.
Testimonies from people with experience of OUD included in the report back Pleus’s claim that many larger organizations, including hospitals receiving OSF funding, are failing people.
“I was failed by two different treatment centers and the state system before I got sober,” one person wrote. “And in 2018, I overdosed … I was actually declared legally dead. I was completely alone during my overdose. The nurses and doctors in the hospital were … shaking their heads full of disgust and pity. The only person who talked to me that night was a police officer who wanted to know where the drugs came from.”
“There are so many mom-and-pop organizations that have popped up. We’re doing the work to fill those gaps that left our kids behind.”
“Patients with substance use disorders at [public hospital] do not have equal access to treatment compared to other health conditions and are being discriminated against … “ wrote another person with lived experience. “It is unreasonable to expect the poorest and most vulnerable patients within our health system to overcome the unnecessary barriers being placed before them … We are appalled that despite so much public health expertise governing our system … we continue to face such tremendous neglect and disregard for the wellbeing of people.”
Small local groups, often started by bereaved parents, can help mitigate these failings with personalized, nonjudgmental assistance—if they have the resources.
“There are so many mom-and-pop organizations that have popped up, after a parent loses their child,” Pleus said. “We’re doing the work to fill those gaps that left our kids behind. That’s not what the big systems are doing.”
A representative from the New York State Office of Addiction Services and Supports (OASAS), which administers the funds, even toured their location and said he was very impressed, according to Pleus.
But then, she said, the agency stopped taking her phone calls. “We haven’t gotten a dollar.”
Image via the Drug Policy Alliance report “New York’s Opioid Settlement Funds: Lessons Learned and Recommendations After the First 3 Years.” It shows the distribution of awards reported by OASAS in FY23-24, in terms of organizations defined as small-scale and large-scale.
The Influence Foundation, which operates Filter, previously received a restricted grant from the Drug Policy Alliance. Filter‘s Editorial Independence Policy applies.